Provider Demographics
NPI:1093593576
Name:HERRERA, AMANDA (LPC ASSOCIATE)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:HERRERA
Suffix:
Gender:F
Credentials:LPC ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2860 S STATE HIGHWAY 161 STE 160-126
Mailing Address - Street 2:
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-7358
Mailing Address - Country:US
Mailing Address - Phone:214-952-2728
Mailing Address - Fax:
Practice Address - Street 1:2860 S STATE HIGHWAY 161 STE 160-126
Practice Address - Street 2:
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-7358
Practice Address - Country:US
Practice Address - Phone:214-952-2728
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-18
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX90949101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional